Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma

355 Background: There is still debated regarding the optimal treatment strategy in cholangiocarcinoma after curative resection. The aim of this study was to analyze the role of adjuvant therapy in R0-resected distal cholangiocarcinoma. Methods: We retrospectively reviewed the medical records of patients who underwent R0 resection for distal cholangiocarcinoma between January 2001 and December 2013 at six cancer centers in Korea. Adjuvant therapy consisted of chemotherapy (CT), chemoradiotherapy (CRT), or radiotherapy (RT). Multivariable Cox proportional hazards model was used to identify prognostic factors for overall survival (OS). Results: A total of 158 patients were included in the analysis; 47 patients (29.7%) had lymph node involvement. Fifty-six patients (35.4%) received adjuvant therapy (CT/CRT/RT: 27/20/9, respectively). Patients with advanced TNM stage (p = 0.001), T3/T4 disease (p = 0.009), positive lymph nodes (p = 0.052) and elevated CA 19-9 (p = 0.071) were more likely to receive adjuvant therapy. The effect of adjuvant therapy varied according to the treatment modality. Multivariable analysis showed a significant improvement in OS with CRT (Hazard ratio (HR) 0.25, 95% CI 0.08-0.83, p = 0.024) and CT (HR 0.21, 95% CI 0.08-0.53, p = 0.001). However, RT alone was associated with shorter OS (HR 2.38, p = 0.040), along with T3/T4 disease (HR 2.12, p = 0.012) and positive lymph nodes (HR 2.30, p = 0.008). In the subset analysis according to lymph node status, adjuvant therapy not including RT alone was associated with a significant OS advantage both in node-negative patients (median, 103.3 vs. 54.9 months, p = 0.037) and node-positive patients (not reached vs. 22.6 months, p = 0.013). Conclusions: Our results showed that patients receiving adjuvant CT or CRT had significant improvement in OS. In addition, the benefit of adjuvant therapy (except RT alone) was observed even in patients with negative lymph nodes.

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Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status

Cancer ◽

10.1002/cncr.27424 ◽

2012 ◽

Vol 118 (18) ◽

pp. 4512-4518 ◽

Cited By ~ 16

Author(s):

Akiko Miyagi Maeshima ◽

Koji Tsuta ◽

Hisao Asamura ◽

Hitoshi Tsuda

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lung Carcinoma ◽

Lymph Node Status ◽

Prognostic Implication ◽

Cell Lung Carcinoma ◽

Nonsmall Cell Lung Carcinoma ◽

Node Status

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Lymph node status assessment for gastric carcinoma: Is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM classification?

Journal of Surgical Oncology ◽

10.1002/(sici)1096-9098(199809)69:1<15::aid-jso4>3.0.co;2-n ◽

1998 ◽

Vol 69 (1) ◽

pp. 15-20 ◽

Cited By ~ 40

Author(s):

Yasuhiro Kodera ◽

Yoshitaka Yamamura ◽

Yasuhiro Shimizu ◽

Akihito Torii ◽

Takashi Hirai ◽

...

Keyword(s):

Lymph Node ◽

Gastric Carcinoma ◽

Lymph Nodes ◽

Tnm Classification ◽

Lymph Node Status ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Node Status ◽

Status Assessment

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Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

Journal of Clinical Medicine ◽

10.3390/jcm8040545 ◽

2019 ◽

Vol 8 (4) ◽

pp. 545 ◽

Cited By ~ 1

Author(s):

Alexandra Caziuc ◽

Diana Schlanger ◽

Giorgiana Amarinei ◽

George Calin Dindelegan

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Early Stage ◽

Locally Advanced ◽

Lymph Node Status ◽

Breast Cancers ◽

Axillary Clearance ◽

Node Status ◽

Response To Chemotherapy

The status of axillary lymph nodes is an important prognostic factor in the outcome of breast cancer tumors. New trials changed the attitude towards axillary clearance. In the era of development of new immune therapies for breast cancer, it is important to identify a biomarker that can predict lymph node status. Tumor-infiltrating lymphocytes (TILs) are a valuable indicator of the immune microenvironment that plays the central role in new anticancer drugs. Although the correlation between TILs and response to chemotherapy was established by previous studies, our retrospective study investigated the correlation between TILs and lymph node status. We analyzed data on 172 patients. According to stage, patients were divided in two groups: patients who underwent primary surgical treatment (breast-conserving or mastectomy and sentinel lymph node (SLN) biopsy +/− axillary clearance in conformity with lymph node status) and patients who received chemotherapy prior to surgical treatment (breast-conserving or mastectomy + axillary clearance). We showed a good inverse correlation between TILs and lymph nodes status for both early stage and locally advanced breast cancers. Moreover, TILs are a predictor for positive lymph nodes in the axilla in patients undergoing axillary clearance after SLN biopsy, with no statistical difference between the intrinsic or histological subtype of breast cancers. We also obtained a significant correlation between TILs and response to chemotherapy with no significative difference according to histological subtype. Although further data have still to be gathered before meeting the criteria for clinical utility, this study demonstrates that TILs are one of the most accredited forthcoming biomarkers for breast cancer (BC) patients.

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Nodal Status and Clinical Outcomes in a Large Cohort of Patients With Triple-Negative Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.1877 ◽

2011 ◽

Vol 29 (19) ◽

pp. 2628-2634 ◽

Cited By ~ 82

Author(s):

Leonel F. Hernandez-Aya ◽

Mariana Chavez-MacGregor ◽

Xiudong Lei ◽

Funda Meric-Bernstam ◽

Thomas A. Buchholz ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Clinical Outcomes ◽

Tumor Size ◽

Large Cohort ◽

Nodal Status ◽

Lymph Node Status ◽

Significant Difference ◽

Positive Lymph Nodes

Purpose To evaluate the clinical outcomes and relationship between tumor size, lymph node status, and prognosis in a large cohort of patients with confirmed triple receptor–negative breast cancer (TNBC). Patients and Methods We reviewed 1,711 patients with TNBC diagnosed between 1980 and 2009. Patients were categorized by tumor size and nodal status. Kaplan-Meier product limit method was used to calculate overall survival (OS) and relapse-free survival (RFS). A Sidak adjustment was used for multiple group comparisons. Cox proportional hazards models were fit to determine the association of tumor size and nodal status with survival outcomes after adjustment for other patient and disease characteristics. Results Median age was 48 years (range, 21 to 87 years). At a median follow-up of 53 months (range, 0.7 to 317 months), there were 614 deaths and 747 recurrences. The 5-year OS was 80% for node-negative patients (N0), 65% for one to three positive lymph nodes (N1), 48% for four to nine positive lymph nodes (N2), and 44% for ≥ 10 positive lymph nodes (N3; P < .0001). The 5-year RFS rates were 67% for N0, 52% for N1, 36% for N2, and 33% for N3 (P < .0001). Pairwise comparison by nodal status showed that when comparing N0 with node-positive disease, there was a significant difference in OS and RFS (P < .001 all comparisons). However, when comparing N1 with N2 and N3 disease regardless of tumor size, there were no significant differences in OS or RFS. Conclusion In patients with TNBC, once there is evidence of lymph node metastasis, the prognosis may not be affected by the number of positive lymph nodes.

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